Cancer generally refers to one of a group of more than 100 diseases caused by the uncontrolled growth and spread of abnormal cells that can take the form of solid tumors, lymphomas, and non-solid cancers such as leukemia. Unlike normal cells, which reproduce until maturation is attained and then only as necessary for replacement, cancer cells grow and divide endlessly, crowding out nearby cells and eventually spreading to other parts of the body, unless their progression is stopped. Once cancer cells metastasize by leaving a tumor, they will travel through the bloodstream or lymphatic system to other parts of the body, where the cells begin multiplying and developing into new tumors. This sort of tumor progression makes cancer dangerously fatal. Although there have been great improvements in diagnosis, general patient care, surgical techniques, and local and systemic adjuvant therapies, most deaths from cancer are still due to metastases and other cancers that are resistant to conventional therapies including radiation and chemotherapy.
Radiation therapy is typically only effective for cancer treatment at early and middle stages of cancer, when cancer is localized, and not effective for late stage disease with metastasis. Chemotherapy can be effective at all stages of the disease, but there can be severe side effects, e.g. vomiting, low white blood cells, loss of hair, loss of weight and other toxic effects, to radiation therapy and chemotherapy. Because of such severe side effects, many cancer patients do not or cannot successfully complete a chemotherapy treatment regimen. The side effects of radiation and anticancer drugs can be viewed as resulting from poor target specificity. Anticancer drugs, typically administered intravenously or more rarely orally, circulate through most normal tissues of patients as well as the target tumors. If the drug is toxic to a normal cell, then this circulation will result in the death of normal cells, leading to side effects, and the more toxic the drug to normal cells, the more serious the side effects. Due to these and other problems, some highly cytotoxic chemotherapeutic agents, agents with nanomolar or sub-nanomolar IC50 values against cancer cells, have not been successfully developed into approved drugs.
Prodrugs have been investigated as a means to lower the unwanted toxicity or some other negative attribute of a drug without loss of efficacy. A prodrug is a drug that has been chemically modified to render it inactive but that, subsequent to administration, is metabolized or otherwise converted to the active form of the drug in the body. For example, in an effort to improve drug targeting, prodrugs have been developed that are activated under hypoxic conditions. Hypoxia creates a bioreductive environment, and certain anti-cancer agents have been converted into prodrugs that can be activated in such environments. See the reviews by Naylor et al., May 2001, Mini. Rev. Med. 1(1):17-29, and Denny, 2001, Eur. J. Med. Chem. 36: 577-595. “Hypoxia” is a condition of low oxygen levels; most solid tumors larger than about 1 mm in diameter contain hypoxic regions (see the references Coleman, 1988, J. Nat. Canc. Inst. 80: 310; and Vaupel et al., Cancer Res. 49: 6449).
As a tumor grows, it requires a blood supply and thus the growth of new vasculature. The new vasculature that supports tumor growth is often highly unordered, leaving significant portions of the tumor under-vascularized and subject to intermittent vascular blockage. The vascular architecture of the tumor can contribute significantly to the cancer's ability to survive drug therapy in at least two different ways. First, if the drug must reach the cancer through the bloodstream, then not as much drug will reach the under-vascularized, hypoxic areas of the tumor. Second, to the extent the drug requires oxygen to be effective, then the drug will be less effective in the hypoxic regions of the tumor.
Conversely, however, the hypoxic environment is conducive to reductive events that can be used to generate reduced derivatives of a variety of chemical groups (see the reference Workman et al., 1993, Cancer and Metast. Rev. 12: 73-82), and bioreductive prodrug compounds have been developed to exploit such environments. These prodrugs include the antibiotics Mitomycin C (MMC) and Porfiromycin (POR), N-oxides such as Tirapazamine (TRZ; see the reference Zeeman et al., 1986, Inst. J. Radiot. Oncol. Biol. Phys. 12: 1239), quinones such as the indoloquinone E09 (see the reference Bailey et al., 1992, Int. J. Radiot. Oncol. Biol. Phys. 22: 649), cyclopropamitosenes (EP-A-0868137), and a tertiary amine-N-oxide analogue of Mitoxantrone (AQ4N) that is activated by cytochrome P450 3A4 (see the references Patterson, 1993, Cancer Metast. Rev. 12: 119; and Patterson, 1994, Biochem. Pharm. Oncol. Res. 6: 533).
Other bioreductively activated prodrug compounds include the nitroimidazole derivatives that have been reported to be useful in cancer radiotherapy as radio-sensitizing agents (see the patent publications EP312858 and WO91/11440) and potentiatiors of chemotherapeutic agents (see U.S. Pat. No. 4,921,963). Nitroimidazole has also been conjugated to the anti-cancer agent PARP 5-bromoisoquinolinone (see the reference Parveen et al., July 1999, Bioorg. Med. Chem. Lett., 9:2031-36). The nitroimidazole moiety itself is, however, somewhat cytotoxic to normal cells, because it undergoes redox cycling and generates superoxides under oxygenated conditions.
Bioreductively activated prodrug compounds that include a nitroimidazole linked to a variety of anti-neoplastic agents has been described in A 2-NITROIMIDAZOLE CARBAMATE PRODRUG OF 5-AMINO-1-(CHLOROMETHYL)-3-[5,6,7-TRIMETHOXYINDOL-2-YL)CARBONYL]-1,2-DIHYDRO-3H-BENZ[E]INDOLE (AMINO-SECO-CBI-TMI) FOR USE WITH ADEPT AND GDEPT, M. P. Hay et al., Bioorganic & Medicinal Chemistry Letters 9 (1999) 2237-2242, and PCT publication WO 00/64864. In all of the prodrugs described in these documents, the nitroimidazole is directly linked to a carbamate linker and the anti-neoplastic agent is protected at a nitrogen via a carbamate or at a carbon via an ester linkage.
Thus, there remains a need to provide drugs to treat cancer. Such drugs would be especially beneficial if they targeted cancer cells more effectively than current drugs and had fewer, less serious side effects. The present compounds and methods help meet this need.